How Pharmacy Benefits Can Benefit More People

Roughly 50% of all U.S. adults report difficulty affording health care costs. Of those taking prescription drugs, one in four say they struggle to afford the cost of their medication. Affordability most impacts individuals taking multiple medications and those with annual household incomes less than $40,000.¹ This can lead to limited medication access, reduced patient compliance and decreased health outcomes.

Published research by the Kaiser Family Foundation affirms the need for increased medication affordability: “The cost of health care often prevents people from getting needed care or filling prescriptions. About a quarter of adults say they or a family member in their household have not filled a prescription, cut pills in half, or skipped doses of medicine in the last year because of the cost, with larger shares of those in households with lower incomes, Black and Hispanic adults, and women.” Additionally, elderly patients 65 years or older “report difficulty paying for various aspects of health care, especially services not generally covered [… such as] prescription drug costs.” ¹

Patients should not bear the burden of high medication costs. As an intermediary between payors and pharmaceutical manufacturers, pass-through pharmacy benefit managers (PBMs) are uniquely positioned to improve prescription affordability. By acting with the patient in mind and aligning with plan sponsor needs, meaningful actions can be taken to lower prescription drug costs so patients can put their health first.

An Industry Alternative
For nearly 20 years, Navitus has helped plan sponsors and health plans achieve significant cost savings and improved member health under the desired pharmacy benefit. Since its founding, Navitus’ transparent, full pass-through pharmacy benefits model has removed unnecessary cost from the drug supply chain rather than shifting it. Each year, clients realize controlled cost and savings compared to their prior PBM. In fact, new clients that switched from another PBM to Navitus in 2021 saved an average of 16% in drug spend.” ²

How does Navitus deliver more value to plan sponsors and their members each year?

Unlike the traditional PBM model, Navitus passes along 100% of all rebates and discounts received through to clients. Further drug cost reduction can be delivered by implementing a high-performance formulary that offers lower-cost alternatives like generics or less expensive brand name drugs when clinically appropriate.

Partnering to Expand Impact
Navitus joined CivicaScript^TM; as a founding member in July 2022. These organizations are aligned in their efforts to tackle medication affordability and the challenges of high-cost generic medications that health care consumers encounter due to a lack of competition in the market. CivicaScript, a statutory public benefit company dedicated to bringing lower costs generic medicines to U.S. consumers, is committed to improving drug price transparency and is a natural partner with Navitus. Their combined efforts will enable greater access to and affordability of important medications for the people who need them, including the nearly 9 million members Navitus proudly serves. As CivicaScript manufacturers and releases historically high-cost generic medications to the market at lower prices, Navitus will help to make these available to clients and members under the pharmacy benefit.

This work is already underway.  In August 2022, CivicaScript began offering its first landmark generic drug, abiraterone acetate 250mg tablets. Lumicera Health Solutions, a wholly owned subsidiary of Navitus and the cornerstone of its specialty pharmacy solution, is one of two pharmacy distribution partners. The ability to provide abiraterone through Lumicera is a first step to making affordable generic medications more accessible to millions of patients that rely on the drugs to live their best lives. By partnering across the drug delivery system, these organizations are leading the way for greater impact on this issue. 

Putting People First
Navitus’ work is mission-driven and rooted in the belief that when medications are more affordable for the people who need them, health improves, and costs go down. Throughout its history, countless members have been positively impacted by its focus and commitment to optime patient well-being and remove unnecessary costs. To learn more about Navitus and how pass-through PBMs make meaningful impact, visit Navitus.com.

References:

1. ​​​​​​​​​Americans’ Challenges with Health Care Costs | KFF
2. Navitus. 2021. Drug Trend Report.